Minimally Invasive Trends in Common General Surgery Procedures from 2007-2013: An Analysis of the National Inpatient Sample

Zhamak Khorgami, Carmen Ruiz, C. Anthony Howard, MD, Guido M Sclabas, MD. Department of Surgery, The University of Oklahoma, College of Medicine, Tulsa, Oklahoma, USA

Background: Minimally invasive surgical procedures have been progressively adopted over the past two decades. Laparoscopic procedures are being used increasingly for abdominal operations, and some open procedures have been replaced by their laparoscopic alternatives. This study was designed to review trends of laparoscopic versus open general surgical procedures in the United States.

Methods: A retrospective analysis of the 2007-2013 Nationwide Inpatient Sample (NIS) Healthcare Cost and Utilization Project (HCUP) database was performed. Patients who had appendectomy (excluding incidental appendectomy), cholecystectomy, colectomy, rectal resection, inguinal/femoral hernia repair, and ventral hernia repair were included. Patients were selected based on Diagnosis-Related Group (DRG) codes and ICD-9 codes for the primary procedure performed during each admission. Other laparoscopic procedures could not be identified based on available codes. 81,112 patients (6.9%) less than 16 years of age were excluded. Trends for each type of procedure were evaluated during the study period. The Chi-Square test (Mantel-Haenszel extension) was used for trend analysis.

Results: 1,098,072 patients were evaluated in the included six procedure groups. Laparoscopic cholecystectomy was performed in 86.8% of the cases in 2007 with a gradual, slight increase over the study period (90.4% in 2013). Laparoscopic appendectomies showed a significant increase from 67.2% in 2007 to 85.5% in 2013 (P<0.001). Laparoscopic colon and rectal resection were not identifiable in 2007 but increased over the study period; laparoscopic colectomies increased rapidly to 32.3% up to 2009 (P<0.001), and then increased slowly to 39.5% in 2013. Laparoscopic Rectal resection showed a linear increase to 9.8% in 2013 (P<0.001). Laparoscopic groin or ventral hernia repair was not identifiable in the 2007 dataset, but laparoscopic inguinal/femoral hernia and laparoscopic ventral hernia repair increased to 10.5% and 20.7%, respectively, in 2009 (P<0.001), and both plateaued from 2009 to 2013.

Conclusion: Laparoscopic cholecystectomy and appendectomy have been widely accepted and have essentially replaced their open counterparts. However, the percentage of laparoscopic inguinal and ventral hernia repair leveled off over the last four years of the study period at approximately 10% and 20%, respectively. The percentage of laparoscopic rectal resection and laparoscopic colectomy showed a very small increase over the last four years of the study period to reach to approximately 10% and 40% of performed procedures, respectively. Through 2013, increases in laparoscopic colon and hernia procedures appear to have leveled off, leaving the open technique as the more common approach for these operations.